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Complex Implant Surgery

What is complex implant surgery?

It is the branch of oral and maxillofacial surgery that deals with the use of dental implants in cases where there is an insufficient quantity of bone for the insertion of “standard” implants and specific reconstructive and regenerative techniques for the missing bone are necessary.

These allow the normal shape and volume of the maxilla and mandible to be recreated, thus allowing the insertion of implants to create fixed or semi-fixed prostheses supported by the implants that would otherwise not be usable.

Who needs complex implant surgery?

All patients who have too little bone in their upper and lower jaw to be able to insert “standard” implants and who do not want or cannot use traditional fixed prostheses (bridges) or mobile ones (dentures and frameworks).

There are various categories of patients who require complex implant surgery techniques:

Patients who have lost their teeth due to periodontal disease (so-called pyorrhea) or who have been without some or all of their teeth for a long time find themselves with a very thin or “low” mandibular or maxillary bone which prevents the insertion of implants

Patients who have suffered facial trauma as a result of which they have lost not only teeth but also the jawbone around them

Patients who have a congenital (since birth) lack of teeth and who often do not even have enough bone in the toothless areas to insert implants

Patients who have undergone bone segment removal due to benign and malignant facial tumors

What are the most common complex implant surgery procedures?

Maxillary sinus lift

When teeth are missing in the back jaw (where the premolars and molars are located), it can sometimes be impossible to insert implants due to the presence of the maxillary sinus, which is a cavity that communicates with the nose and is filled with air: its presence greatly reduces the available bone and makes it difficult or impossible to ensure that the implants “take root” or hold up when they have to support the pressure caused by chewing.

Maxillary sinus lift is a procedure that allows you to recreate favorable conditions for the insertion of implants by increasing the volume of bone at the level of the maxillary sinus. This can be done with “synthetic” bone grafting materials (most of the time) or with the patient’s own bone, taken from other areas of the mouth.

Guided Bone Regeneration and Bone Grafting (GBR)

When the bone of the maxilla or mandible becomes too thin or low to accommodate implants, techniques that allow the volume of the bone to be increased may be indicated. These are regenerative techniques that use synthetic materials or the patient’s bone taken from other areas of the mouth or, in more complex cases, even from outside the mouth.

In this way, the lack of bone is corrected and, in the same operation or a few months later, optimal conditions are created to insert implants of adequate size to then support the chewing load of the teeth that will be fixed to the implants.

What are the phases of a complex implant surgery?

Before starting, it is a good idea to have a general dental examination, which also includes taking x-rays to assess the condition of the teeth that are still in the mouth, the possible presence of gingivitis or periodontal disease (what was once called pyorrhea), the quality of any prosthetic work already present in the mouth, the level of oral hygiene, the type of occlusion of the teeth between them, whether it is necessary to align the other teeth with orthodontic appliances, etc.

During the first visit, information will also be collected to exclude the presence of other types of pathologies (for example, severe diabetes, a recent heart attack, the use of particular medications) that contraindicate implant surgery.

Once it has been established that there are favorable general and local conditions, it is a good idea to assess the amount of bone in the areas without teeth with a targeted examination and x-rays.

To optimize the initial evaluation, it is often recommended to take impressions of the two dental arches and prepare plaster models. A study can be performed on these models (which is done in collaboration with a dental technician) to simulate the ideal position and shape of the missing tooth(s).

Furthermore, the plaster models can be used to build so-called diagnostic masks, which are nothing more than small mobile devices that are placed in the mouth when a CT scan is performed to evaluate the quality and quantity of the bone that must receive the implants. Thanks to these tests, the extent of the lack of bone can be precisely assessed.

At this point it is possible to choose, among the various reconstructive possibilities of the missing bone, the one that is most suitable for the patient.

In a good part of the cases it is possible to perform a regenerative/reconstructive technique of the missing bone under local anesthesia and in an outpatient setting, even if in sterile conditions to guarantee the absence of contamination.

Only in the most complex cases, when a very large reconstruction is needed, in patients who are afraid (so-called dental phobic patients) or in patients with less than optimal general conditions, other forms of anesthesia may be necessary, such as local anesthesia combined with sedation or general anesthesia.

In favorable cases, it is possible to insert the implants in the same operating session, while in others it is best to wait a few months (3-6 months) before inserting the implants, to obtain adequate attachment of the material used.

After the insertion of the implants, as in the case of “normal” implant surgery, the teeth can be screwed/cemented to the implants immediately or after a few months (2-3).

During the waiting phase, the patient will wear temporary prostheses, which allow a completely normal life.

The patient will then be given some documents containing all the details regarding the various phases of treatment, preparation for the operation and how to manage the post-operation.